51129/ 9 '76) I ! ^^if�� i'lyti-. GOT
NO. STEW'
gp�LIION FOR PLUMBING PERMIT
® �m C��OF CUPERTINO
Sanitary No.
Date M1,
6— Permit No. lr/ / Y Yr
Pee $ 2 Sy
A�F}e ior�i�he�¢byry�aylS�tq�tjycsCity of Cupertino for a permit to install plumbing
plpcS�and1Yor utur i I verse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner
By / 'may, Lcf c"�y�1
CONTRACTD'R, AGENT
Phone dy/- 3 3 7 0
State License Z3
Address 4FS-7/ �.r
°'C
Approved CCJ.g-<-�IV7-
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I FEES
To Curb
To Prnn. Line
Lavatories To Existin
Kitchen $ink Not Conn.
Dish Washer Sewer Box
Machine
Comb.Sink&Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
illain Drain Fee
WaterLeader
Storm Drain Fee
Sprinkler Valve11
Water Svs. Fee I/
Vac
Filter
Total Fee